Provider Demographics
NPI:1902831704
Name:INOUE, SCOTT R (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:INOUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:333 SAN CARLOS WAY
Mailing Address - Street 2:STE B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2037
Mailing Address - Country:US
Mailing Address - Phone:209-956-5122
Mailing Address - Fax:209-956-3769
Practice Address - Street 1:333 SAN CARLOS WAY
Practice Address - Street 2:STE B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2037
Practice Address - Country:US
Practice Address - Phone:209-956-5122
Practice Address - Fax:209-956-3769
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0249790Medicare ID - Type Unspecified